Substance Use Disorders

Question 1

Diagnosis andn DSM 4 criteria for SUD

Answer 1

Substance use disorders are characterized by a problematic pattern of substance use causing impairment or distress, as manifested by at least two of the follow- ing within a 12-month period:

■ Using substance more than originally intended.
■ Persistent desire or unsuccessful eforts to cut down on use. ■ Signiicant time spent in obtaining, using, or recovering from substance.
■ Craving to use substance.
■ Failure to fulill obligations at work, school, or home.
■ Continued use despite social or interpersonal problems due to the
substance use.
■ Limiting social, occupational, or recreational activities because of
substance use.
■ Use in dangerous situations (e.g., driving a car).
■ Continued use despite subsequent physical or psychological problem
(e.g., drinking alcohol despite worsening liver problems).
■ Tolerance (needing higher amounts of the substance to achieve the desired
efect or experiencing diminished efects when repeating the same dose).
■ Withdrawal (a substance-speciic syndrome occurring when a patient stops
or reduces heavy/prolonged substance use).
Note that these criteria remain the same regardless of what substance(s) the patient is using. he disorder may be classiied as mild, moderate, or severe depending on the number of criteria met.

Question 2

Alcohol Testing

Answer 2

■ Stays in system for only a few hours. ■ Breathalyzer test, commonly used by law enforcement. ■ Blood/urine testing more accurate.
■ Urine screening for metabolite (ethyl glucuronide) — not useful for
assessing acute intoxication, but can indicate alcohol use over the
preceding 2–5 days.

Question 3

Cocaine Testing

Answer 3

Urine drug screen positive for 2–4 days (up to 8 days for heavy
users).

Question 4

Amphetamine Testing

Answer 4

■ Urine drug screen positive for 1–3 days.

■ Most assays have poor sensitivity and/or speciicity.

Question 5

Phencyclidine (PCP) Testing

Answer 5

■ Urine drug screen positive for 4–7 days. ■ OTC cold medications may yield false positive.
■ Creatine kinase (CK) and aspartate aminotransferase (AST ) are often
elevated.

Question 6

Sedative-hypnotic testing

Answer 6

In urine and blood for variable amounts of time.
Barbiturates:
■ Short-acting (pentobarbital): 24 hours
■ Long-acting (phenobarbital): 3 weeks

Benzodiazepines:
■ Short-acting (e.g., lorazepam): up to 5 days
■ Long-acting (diazepam): up to 30 days

Question 7

Opioid Testing

Answer 7

■ Urine drug test remains positive for 1–3 days, depending on opioid
used.
■ Routine screening tests detect morphine, which is the eventual
metabolite of all natural opioids.
■ Buprenorphine, synthetic opioids (methadone, fentanyl, tramadol)
and semi-synthetic opioids (oxycodone, hydrocodone) will not be
detected on routine screening (order separate assay).

Question 8

Marijuana Testing

Answer 8

Urine detection:
■ After a single use, about 3 days. In heavy users, up to 4 weeks (THC
is released from adipose stores).

Question 9

What does alcohol activate and what does it inhibit?

Answer 9

activates gamma-aminobutyric acid (GABA), dopamine, and
serotonin receptors in the central nervous system (CNS).

It inhibits
glutamate receptor activity and voltage-gated calcium channels. GABA
receptors are inhibitory, and glutamate receptors are excitatory; thus, alcohol
is a potent CNS depressant.

Answer 10

Clinical Presentation of Alcohol Intoxication
Effects BAL Impaired ine motor control 20–50 mg/dL Impaired judgment and coordination 50–100 mg/dL Ataxic gait and poor balance 100–150 mg/dL Lethargy, diculty sitting upright, diculty with memory, 150–250 mg/dL
nausea/vomiting Coma (in the novice drinker) 300 mg/dL Respiratory depression, death possible
400 mg/d

Question 11

Why do you give thiamine for alcohol intoxication/withdrawal

Answer 11

To prevent wernickes encephalopathy that could also develop into korsakoff syndrome